Cardinal Institute

Are we asking the right questions about special education in West Virginia? Despite increased spending, outcomes for students with disabilities remain stagnant. Families and taxpayers deserve to know what we're already getting for what we already spend.

Charity care and bad debt aren’t the same. For patients, the difference is huge. Charity care means free or discounted care. No collections. Bad debt happens when patients are billed and can’t pay, leading to collections. Hospitals may report both as “uncompensated care,” but patients feel the impact in very different ways. Understanding this distinction matters for real people and real lives in West Virginia.

West Virginia is quite lucky in this regard -- education freedom for all kids regardless of income and not subject to an arbitrary lottery system. Hope Scholarship is a gold-standard model for other states that wish to give children an education option.

Interesting datapoint from KFF. Medicaid expansion correlated with less charity care. Is this because fewer people need debt relief once they have safety-net coverage? Possibly. Though national data finds about 41% of U.S. adults still have some type of healthcare debt, so the problem remains widespread well after ACA implementation. An important nuance on charity care: Hospital Associations regularly count "Medicaid shortfalls" in their community benefit reports. Weak IRS standards are allowing hospitals to count payment differentials toward their non-profit obligation, reducing the actual free care they need to provide.

Throwback Thursday to an incredible day celebrating the universal expansion of the West Virginia Hope Scholarship! Be sure to apply for full funding of the Hope Scholarship before the June 15 deadline! Apply here: buff.ly/ZqTg973

Economic freedom isn't separate from the other freedoms we care about. It's the foundation they rest on. That's why West Virginia's policy choices matter beyond the budget.

Think the Hope Scholarship is draining public schools? Think again. Here’s the truth: West Virginia’s funding formula isn’t based on individual students—it’s built around staffing, buildings, and transportation. When a student chooses Hope, local property taxes and federal dollars don’t go anywhere. Building allowances stay put. Only the state share tied to that one child moves, just as it was designed to. The real budget challenges? They come from decades of declining enrollment, an outdated funding formula, and temporary federal COVID dollars that expanded staffing beyond what’s sustainable.

Did you know there are almost 200 schools that participate in the Hope Scholarship Program? Find your local participating school and submit your application for full funding before the June 15 deadline! Find your local school: buff.ly/5PLh1E0 Apply here: buff.ly/A7FZdJd Application checklist: buff.ly/dlpR98R

🚨 New from @EdunomicsLab: West Virginia spends $15,968 per student—more than Florida, Mississippi, Tennessee, and Louisiana. But the results? All four outperform West Virginia on NAEP. Mississippi leads in 8th-grade reading by 8 points. Florida leads in 4th-grade math by 14 points. More money isn’t delivering better outcomes for our kids. It’s time to ask: Are we funding student success, or just the system?

How many issues do you hear the Trump and Obama administrations agree on? Repealing Certificate of Need is one of them. The federal government has been asking states to do it since the 1980s. The evidence is overwhelming. The only people defending Certificate of Need are the people who benefit from it.

Educational choice. Lower taxes. Worker freedom. That’s how you build a state where people can stay, work, and thrive. At Cardinal, we advance research and solutions that expand opportunity across West Virginia. If you believe in that mission, help us keep going: cardinalinstitute.com/donate

Competition isn't a threat to good education. It's a driver of it. When families have real choices—public, private, microschool, homeschool co-op—every provider has stronger reason to show up for kids. Read @jltroyan_wv's full op-ed in the Charleston Gazette-Mail. ⬇️

In Greenbrier County before the closure, people were having conversations about what to do if they had their baby on the turnpike. The hospital association says it is protecting rural communities. Labor and delivery is what rural communities are built around. If the systems operating there will not provide it, others should be allowed to.

For every $100 a West Virginia hospital collects, less than $1 goes back to patients who can't afford care. Non-profit hospitals owe their communities more than that.

There are no valid arguments for being against school choice x.com/cardinalwv/sta…

Reading scores, 3rd graders to 8th graders, 2015 to 2025. This is a national tragedy.

West Virginia is one of just 7 states still using a resource-based funding formula. That means 45,000 missing students are still generating funding for empty chairs. Time to fund students, not systems.

Hospitals will tell you 75% of their patients are on government insurance that loses them money. They’re counting PEIA in that number. By state law it pays hospitals at least 110% of Medicare, and hospitals can charge above that. It operates much more like a commercial payer than the government payer they claim. It’s also why reference-based pricing could actually help PEIA stay solvent.

Cardinal Chief of Staff @jldobrinsky on the "West Virginia 75% government payer" defense ⬇️ PEIA pays West Virginia hospitals a floor of at least 110% of Medicare. By state law. Floor, not ceiling. Hospitals can charge more. The hospital association groups PEIA with Medicaid to manufacture a 75% government payer number. The actual share is closer to 55%. And even at 55, research shows payer mix is not what drives commercial prices. Market power is.